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Testis and epididymis
General
Testicular biopsy

Reviewer: Turki Al-Hussain, M.D. (see Reviewers page)
Revised: 14 April 2013, last major update August 2012
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
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Biopsy results for azoospermia (no sperm present, no endocrine abnormalities)
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  1. Germ cell aplasia/Sertoli cell only syndrome (29%): tubular basement membrane thickening, no germ cells, usually normal number of Leydig cells
  2. Spermatocytic arrest (26%): usually early arrest at primary spermatocyte level (no spermatids, no spermatozoa), normal Leydig cells; may be late arrest (no spermatozoa only)
  3. Generalized fibrosis (18%)
  4. Normal (27%): usually associated with bilateral obstruction as seen in Young’s syndrome (also chronic sinopulmonary infections) or testicular blockage (50% of tubules lack lumina; disorderly maturation of germ cells); surgery (epididymovasotomy, vasovasotomy) is often successful
Azoospermia due to known obstruction:

Biopsy results for no sperm count due to endocrine abnormalities (testicular failure)
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  1. Hypogonadotrophic eunuchoidism (60%): low FSH and LH levels; small infantile tubules with few/no Leydig cells, scattered spermatogonia and Sertoli cells
  2. Klinefelter syndrome (30%): XXY karyotype, tubular fibrosis, prominent basement membrane thickening and Leydig cell hyperplasia; associated with increased incidence of breast carcinoma, possibly Leydig cell tumors, extragonadal (mainly mediastinal) germ cell tumors
  3. Testicular aplasia (10%): absence of testicular tissue, high urinary LH and FSH

Biopsy results for oligospermia
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  1. Incomplete spermatocytic arrest: some tubules normal, some with arrest
  2. Regional or incomplete fibrosis
  3. Spermatogenic hypoplasia: tubules with reduced number of germ cells that are also disordered
  4. Tubular hyalinization: includes Kleinfelter syndrome (small diameter tubules with thickened basement membrane and increased Leydig cells)
  5. Mixed atrophy: synchronous occurrence of seminiferous tubules with germ cells and tubules with Sertoli cells only
  6. Normal spermatogenesis: associated with duct obstruction

Fine needle aspiration (FNA)
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End of Testis and epididymis > General > Testicular biopsy


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